Bartleson J D, Maus Timothy P
Departments of Neurology (JDB) and Radiology (TPM), Mayo Clinic, Rochester, MN.
Neurol Clin Pract. 2014 Aug;4(4):347-352. doi: 10.1212/CPJ.0000000000000043.
Epidural injections of local anesthetic or a corticosteroid are frequently given to diagnose and treat patients with radicular pain originating from any spinal level. The best-quality evidence supports a transforaminal approach in the lumbar spine. Many patients experience substantial benefit from a single therapeutic injection. Depending upon the benefit obtained, additional injections may be administered. Selective nerve blocks with local anesthetic alone can identify the spinal nerve mediating the patient's pain. Serious short-term risks are rare but occur; long-term risks are infrequent and can be due to systemic effects of multiple corticosteroid injections. Patients who have failed conservative therapy or are not candidates for surgical intervention can be considered for epidural steroid injections to relieve their radicular pain temporarily.
硬膜外注射局部麻醉药或皮质类固醇常用于诊断和治疗源自任何脊髓节段的神经根性疼痛患者。质量最佳的证据支持在腰椎采用经椎间孔入路。许多患者单次治疗性注射后获益显著。根据获得的益处，可进行额外注射。单纯使用局部麻醉药进行选择性神经阻滞可确定介导患者疼痛的脊神经。严重的短期风险虽罕见但确实存在；长期风险不常见，可能是多次皮质类固醇注射的全身效应所致。保守治疗失败或不适合手术干预的患者可考虑进行硬膜外类固醇注射以暂时缓解其神经根性疼痛。
